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Thursday, May 24, 2012

NOTE:Most commonly-used flame retardants belong to a class of chemicals known as polybrominated diphenylethers, or PBDEs, about which we have previously published extensively.

An important recent study by the U.C. Davis MIND Institute, published in the journal Human Molecular Genetics, notes that "PBDEs have been used in a wide range of products, including electronics, bedding, carpeting and furniture. They persist in the environment and accumulate in living organisms, and toxicological testing has found that they may cause liver toxicity, thyroid toxicity and neurodevelopmental toxicity, according to the U.S. Environmental Protection Agency."You can read more about the possible health effects of PBDE exposures HERE, andHERE, andHERE,andHERE.

If you pick up a cushion from any sofa or piece of furniture that has foam, you're likely to find a small white tag that reads: "This article meets all flammability requirements of California Bureau of Home Furnishings technical bulletin 117." The law, referred to as TB 117, was passed in California in 1975.

It says that the foam inside upholstered furniture must be able to resist a flame, such as from a cigarette lighter or a candle. Rather than make different furniture just for California, big furniture makers adhere to those standards in all 50 states and even Canada.

Some scientists and lawmakers are now starting to think this policy, designed to make us safer, might actually have the opposite effect.

A Law Backed by Industry

There's really only one way to take foam and make it flame retardant: with chemicals. Not trace amounts, either. You have to put as much as 2 pounds of flame-retardant chemicals into the foam of each sofa.

According to the American Home Furnishings Alliance, more than 80 percent of furniture sold in the U.S. contains foam treated with flame retardant chemicals.

The problem, chemists say, is that the chemicals don't just stay inside the sofas — they turn up in household dust and in human blood and breast milk. Some of these chemicals cause cancer in lab animals, and studies suggest connections between some of the chemicals and abnormal brain development in humans.

"...once the fire gets to the foam, the sofa's going to burn. It'll burn just as well with the fire retardant as without it." --Donald Lucas, Lawrence Berkeley National Laboratory

Over the years, the most worrisome chemicals have been phased out, but they're still present in older furniture. Meanwhile, new chemicals come online and scientists scramble to test them. For these reasons, California lawmakers have tried five times to change this law.

"It's enormously frustrating," says state Sen. Mark Leno, a Democrat.

Leno's recent bill had the support of furniture makers, firefighter groups and doctors. All of them wanted the chemicals out of furniture, but the bill died in committee. Every lawmaker who voted against it had received campaign contributions from the chemical industry.

Leno says it's the same every time one of these bills comes up. He goes from office to office, trying to drum up support from fellow lawmakers.

"In the waiting room of the office I'm leaving is a lobbyist for the chemical industry. So they'll have the last word," he says.

Do the Chemicals Work?

Last year, a burn doctor from Seattle named David Heimbach was a star witness hired by the chemical industry to testify to California lawmakers. He described a 7-week-old girl he treated who was burned in a fire started by a candle that ignited a chemical-free pillow.

It turned out that there was no 7-week-old burn victim and no candle fire. After a Chicago Tribune investigation, Heimbach admitted he made up the story.

So do flame retardants actually prevent fires?

"What we found is the addition of the fire retardants really didn't reduce fires significantly, or at least we couldn't tell that it reduced it at all," says Donald Lucas, a flammability scientist at Lawrence Berkeley National Lab.

Lucas says the reason flame retardants don't stop fires is that fires don't start inside the sofa — they start on the surface of the sofa, on the fabric. And the law says nothing about the fabric, just the foam.

"Usually, once the fire gets to the foam, the sofa's going to burn," he says. "It'll burn just as well with the fire retardant as without it."

Lucas points out that today, there are better ways to make furniture fire resistant using special fabrics or fire barriers between the fabric and the foam. After four decades of the existing law, California regulators say they're looking into it.

Wednesday, May 23, 2012

Will statistical analytics make for healthier, happier babies? Or, more-anxious adults?The day their son was born, Monica Rogati and her husband began obsessively plotting his life via thousands of bits of data they punched into the smartphone app Baby Connect. They called the data “baby I/O,” a reference to the computing expression input/output and the kind of “geeky joke,” as Rogati puts it, that you might expect from a pair of professional data crunchers with doctorates from Carnegie Mellon.

This may sound like a lot of information for a very small person, but it’s typical grist for apps designed to tally a baby’s every blink and burp and sniffle, in hopes of charting his development over time. Among Baby Connect’s competitors are Total Baby, Baby Log, iBabyLog, Evoz, and the new Bedtime app from Johnson’s Baby, as well as Web-based programs such as Trixie Tracker (which an enterprising stay-at-home dad named after his daughter). Since Baby Connect launched, in 2009, Rogati and 100,000 other users have logged 47 million “events,” including 10 million diaper changes (with annotations in exacting and unmentionable detail).

At their most basic, these first-generation baby-data apps offer tech-savvy parents a substitute for handwritten diaper-change and feeding logs. The apps’ greater innovation, however, has been in charting and analyzing children’s data, in the process making parenthood a more quantifiable, science-based endeavor.

Forthcoming versions of baby-data apps are poised to bring even more dramatic change, allowing parents to compare their child with other children in great detail.

In place of sidelong glances on the playground and calls to the pediatrician, mothers and fathers will have a new and more definitive way of answering an old question: Is my child normal? What remains to be seen is whether this new trove of information will reduce the anxieties of early parenthood or, by allowing constant, nervous comparisons, bring them into sharper relief.

The first generation of data apps has had the potential to decrease parental anxiety, by helping to make sense of early infancy. A tired new parent can find solace in a graph showing sleep patterns emerging after the chaos of a baby’s early weeks. The difference between a Trixie Tracker scatter plot of a one-month-old’s sleep and a six-month-old’s sleep (charting sleep-session start times against their duration) is stark: the first image is a depressing mess of dots with little differentiation between day and night.

By six months, though, the dots begin clustering in a reassuring pattern, with a correlation appearing between nighttime and longer stretches of sleep.

The payoff for Rogati’s data-entry efforts came when her son started waking randomly during the night. Was it the introduction of oatmeal? Or was a later afternoon nap the culprit? Rogati wasn’t sure, until she isolated the “oatmeal variable,” as she called it, by reviewing aggregated feeding charts and sleep graphs.

Eventually, though, she was no longer satisfied by her son’s own data set. What she really wants is to be able to compare him to the crowd—to run a computer algorithm similar to those she runs as a data scientist at LinkedIn, where she probes a 150-million-person database to answer questions like: Which first names correlate with a successful career?

She doesn’t have long to wait. Evoz has partnered with the hardware manufacturer Belkin to produce an infant monitor that is scheduled to appear on the shelves of mass-market retailers this fall. By gathering and sending recorded data (on everything from sleeping to crying) to Evoz via a home Wi-Fi network, the monitor will free parents from the chore of logging data manually. More important, once the database is big enough, it will also let parents compare their baby with fellow users’ babies of the same age and gender. Other app makers, including Baby Connect and Johnson’s Baby, are considering similar updates later this year.

Rogati imagines that this crowdsourcing will provide an early-warning system to help parents determine what is and isn’t out of the ordinary: “He’s in the 50th percentile, he is perfectly normal.” Or “This is in the 99.9th percentile. Maybe this is not normal.” It will be a way, she says matter-of-factly, “to debug your baby for problems.”

Landmark School'sReach program, created in a unique partnership with Endicott College, offers high school graduates and college freshman and sophomores, ages 18 - 20, a unique opportunity to prepare for the rigors of college and expand their skill set in just 10 months. This day program is designed to meet the needs of students who need more support to complete college successfully and thrive.

"Landmark’s college readiness program is exactly what some students need to bridge the gap between high school and college academics. I wish more students would take advantage of programs like Landmark's because I believe that we'd see more students stay in college and experience greater success.

Landmark's college readiness program is unique in that it endeavors to reach beyond the skills a student needs to get into college and strives to teach the tools a student needs to stay in college and be successful.

It's not just about getting into college; it is about staying there. And about being successful and getting the most of your college experience. Landmark seems to get that in a way that other programs do not."

Tuesday, May 22, 2012

The Anxiety and Attention Skills Coaching Program at NESCA is a time-limited, intensive intervention focused on developing self-regulation skills in children and adolescents with anxiety and/or attentional difficulties that are interfering with their ability to fully engage in their academic, social, recreational, or home environments. It was recently developed on the belief that children and adolescents learn new skills through well-focused interventions that allow for frequent repetition and rehearsal.

The program uses a short term, intensive skills-based approach to teaching emotional awareness and self-regulation. It is designed for children and adolescents who, for a variety of reasons, cannot wait a year to make progress in once-weekly individual therapy, or whose parents report “we tried individual therapy and it did not work.” Individualized interventions encourage quick acquisition of skills through individualized treatment plans and aids, as well as opportunities for generalization to outside environments.

The AASC program is structured as a 12-week program involving 3 one-hour sessions per week with the primary clinician and 1 one-hour session per week of yoga therapy. Specific interventions utilized are highly individualized based on the child’s needs and interests. Intervention strategies utilized include psychoeducation, cognitive behavioral and emotion processing techniques, mindfulness, self-monitoring methods, and behavioral rewards systems.

If needed, the final weeks of the program can involve fading of services out of NESCA and into the natural environment, providing for opportunities to generalize skills. The primary clinician can meet with the child or adolescent at school and/or home. Involvement of teachers, school counselors, or parents can aid the generalization of skills and inform interventions to be continued following completion of the AASC program.

Individual outcomes are monitored closely and continually throughout enrollment. Progress monitoring is conducted with quantitative outcome measures, which are gathered at time of acceptance, once monthly, and at the conclusion of the program. Measures utilized depend on the specific reason for referral, but may include self, parent, and/or teacher report of behavioral symptoms, anxiety, mood, attention, and executive function. Responsiveness to the program is evaluated mid-way through. If for any reason, it is determined that the AASC Program is no longer an appropriate match for the child or adolescent, suitable referrals will be provided and any unused portion of deposited funds will be refunded.

As structured, the AASC program costs $7500, which includes all of the above mentioned services, exclusive of additional cost of travel if services are generalized into the school or home. Additional services are offered by the clinicians, at an additional cost. If an intake evaluation is required to determine appropriateness for the program, this one-hour session is charged at $200. Clinicians are available to attend team meetings, charged at $150 per hour plus travel. While the AASC Program is structured as a 12-week program, some children or adolescents may require additional time to fade services. Services rendered after the 12th week will be charged at an hourly rate of $100 per hour. NESCA is happy to develop contracts with public schools who wish to pay for services as part of an educational plan.

The AASC Program offers a unique approach to intervention. While this is a newly developed program, initial outcomes are positive, showing significant improvement in anxiety and self-regulation in a short period of time. AASC staff members have a wide range of experience in working with children, adolescents, and adults suffering from anxiety and attentional dysregulation, both within the clinical and research realms.

The expertise of the AASC psychologists and yoga therapist, when combined with the opportunity for rehearsal and repetition of interventions, optimizes short-term outcomes. And when combined with opportunities for generalization and follow-up maintenance, it is believed that the likelihood of sustained long-term improvement is optimized, reducing the need for even more intensive therapeutic placements in the future.

If you have any questions about the AASC Program, please feel free to call to call Dr. Angela Currie at 617-658-9825.

AASC Program Staff

NESCA Director Dr. Helmus is a licensed clinical neuropsychologist who has practiced for more than 16 years. In 1996, Dr. Helmus co-founded Children's Evaluation Center (CEC) in Newton, MA, and then served as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field. Dr. Helmus specializes in the evaluation of children with learning disabilities and attention deficits, as well as primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems.

She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning. She earned her doctorate at Boston University School of Medicine. Her postdoctoral fellowship in pediatric neuropsychology was completed at Children's Hospital in Boston, where she remained on staff for seven years. Concurrently, she served as neuropsychologist to the Pediatric Brain Tumor Clinic at Dana-Farber Cancer Institute in Boston.

Angela M. Currie, Ph.D. - AASC Clinician. Dr. Currie is completing her post-doctoral pediatric neuropsychology fellowship at NESCA and soon will be joining the staff. Dr. Currie specializes in the evaluation of psychiatric disorders in children and adolescents, conducting both neuropsychological and projective assessments. She has extensive experience in the evaluation and treatment of anxiety-based disorders.

At NESCA, Dr. Currie conducts individual therapy and is the primary clinician in the intensive outpatient Anxiety and Attention Skills Coaching (AASC) Program, which focuses on teaching emotional awareness and self-regulation through a structured psychoeducational and CBT-based approach.

Prior to joining NESCA, Dr. Currie completed her pre-doctoral internship at May Institute, Inc. where she conducted outpatient assessments and provided individual and group therapy services. Dr. Currie has provided a wide range school-based mental health services. She has also worked as the director of a therapeutic summer camp, social skills group counselor, educational liaison, and adjunct faculty member at Suffolk University. Dr. Currie received her Ph.D. in clinical psychology from Suffolk University, where her studies centered on children and families.

Katherine DellaPorta, Psy.D. AASC Clinician. Dr. DellaPorta, is completing her post-doctoral pediatric neuropsychology fellowship at NESCA and soon will be joining the staff. In addition to evaluation attentional and learning disabilities, Dr. DellaPorta conducts transition assessments as part of the transition service at NESCA, offers individual therapy and serves as a clinician in the AASC Program.

DellaPorta completed her pre-doctoral internship at Comprehensive Outpatient Services, Inc. (Charles River Counseling Center), where she provided outpatient individual, family, and couples therapy. She also worked as a pediatric neuropsychological examiner at The Center for Autism Spectrum Disorders of Children’s National Medical Center and in a private practice in Columbia, MD. Her training experience also includes conducting individual therapy and psycho-diagnostic assessments of cognitive, academic, behavioral, and emotional functioning in children and adolescents. Dr. DellaPorta received her Psy.D. in clinical psychology from Loyola University Maryland.

Hannah Gould, M.Ed., RYT - Yoga Therapist. Hannah received her certification as a yoga teacher in 2005, and she has enjoyed bringing yoga to children and adults in a variety of settings. She has developed her yoga teaching technique to serve children with Autistic Spectrum Disorders, anxiety and other developmental concerns. Through yoga, she is able to address many areas of need, including self-regulation, sensory integration, relaxation, motor-planning, self-awareness and self-esteem. Hannah uses stories, games and music to make yoga engaging and meaningful to children.

Hannah Gould received her M.Ed. in the education of children with special needs from Simmons College in 1999. She worked as a special educator in a public middle school for two years. From 2001 to the present, Hannah has worked at Academy MetroWest in Natick, MA leading activity-based therapeutic groups for children focused on developing social skills and self-esteem. Hannah has developed a particular interest and expertise in working with students with Asperger’s Syndrome and NLD.

She has presented at conferences and has published an article in the Asperger’s Association of New England (AANE) newsletter pertaining to the particular educational and social needs of this population. She has also provided educational consulting services and academic tutoring with an emphasis on helping these students manage frustration and anxiety related to academic work.

Preliminary results from an ongoing, large-scale study by Yale School of Medicine researchers shows that oxytocin -- a naturally occurring substance produced in the brain and throughout the body -- increased brain function in regions that are known to process social information in children and adolescents with autism spectrum disorders (ASD).

"Our findings provide the first, critical steps toward devising more effective treatments for the core social deficits in autism, which may involve a combination of clinical interventions with an administration of oxytocin," said Gordon. "Such a treatment approach will fundamentally improve our understanding of autism and its treatment."

Social-communicative dysfunctions are a core characteristic of autism, a neurodevelopmental disorder that can have an enormous emotional and financial burden on the affected individual, their families, and society.

Gordon said that while a great deal of progress has been made in the field of autism research, there remain few effective treatments and none that directly target the core social dysfunction. Oxytocin has recently received attention for its involvement in regulating social abilities because of its role in many aspects of social behavior and social cognition in humans and other species.

To assess the impact of oxytocin on the brain function, Gordon and her team conducted a first-of-its-kind, double-blind, placebo-controlled study on children and adolescents aged 7 to 18 with ASD. The team members gave the children a single dose of oxytocin in a nasal spray and used functional magnetic resonance brain imaging to observe its effect.

The team found that oxytocin increased activations in brain regions known to process social information. Gordon said these brain activations were linked to tasks involving multiple social information processing routes, such as seeing, hearing, and processing information relevant to understanding other people.

Other authors on the study include Randi H. Bennett, Brent C. vander Wyk, James F. Leckman, and Ruth Feldman.

Looking for tools that you and your teen can use to plan for the future? You’ve come to the right place.

Self-advocates and government agencies are developing great transition tools. But they’re scattered all over the web and hard to find. Here’s where you’ll discover some of the best tools available, organized by topic.

So, pour a beverage of your choice and start looking around!

How does this work? When you click on a transition topic below, you’ll be taken to a separate page with links to related tools. We’ll add new tools regularly.

Overall, Massachusetts ranks 33rd for the percentage of children who are obese and ranks dead last with the lowest percentage of high school students who meet the recommendation for 60 minutes of moderate to vigorous exercise daily.

Among Massachusetts high school students:

67% of students were not regularly physically active and fare worse than the national average.

Only 17% of students were physically active daily.

82% did not attend physical education classes daily and fare worse than the national average.

Over 23% of children reported not being physically active for 60 minutes on any day.

30% of students reported watching television for 3 or more hours per day on school days.

In a memory from the not so faraway past, I am standing in the hallway outside the locked entry to psychiatric Unit C, removing the strings from my daughter's sweatpants. There is another woman waiting at the door who looks just like me. She could be a nurse, a doctor, a teacher, a professor. I remember this woman. I have seen her in the hospital hallways before; we are on a similar journey. Her daughter is the same height as mine, approaching six feet tall. Her daughter cannot walk more than twenty steps without a walker or wheelchair. Her daughter weighs a mere 105 pounds. I am pulling the strings from my daughter's sweatpants because she is on a suicide watch.

The woman waiting at the door is praying that her daughter will not die of starvation in the most well-fed country in the world. I am praying that medicine, therapy, faith, and love can save my daughter from herself.

How did I get here? What signs did I miss over the last few years? Could I have saved my daughter from this pain? Could I have prevented my family this agony? Are these questions every family asks when a child or sister or mother or friend is hospitalized, in the vortex of a suicidal depression or another mental illness?

Since that day in the hospital, I have learned that love alone will not save someone from depression. You cannot simply love someone back to the safe ground of wellness (oh, that we could!). But you can love someone enough to seek, advocate, and fight for medical treatment. In fact, without that love -- a love that drives you to fight for the life of your loved one -- people like my daughter and the daughter of the mother in the hallway are surely lost.

I cannot read an article or story about a mother losing her son or daughter without crying, without feeling the cutting pain of fear and love that I remember so well. I came so close to losing our child. Those days and months and years, it felt as if I were hanging on to her as she dangled over the side of a cliff, as if I were holding on to her by only a piece of clothing, a very slim piece. I hoped it wouldn't tear, that she wouldn't fall from my grip. Her dad was hanging on, too, and our family and friends behind us. With all of us hanging on for her dear life, we didn't let go. She fought as well, trying her hardest to climb back up. Sometimes she was able to fight, sometimes she fought us to let go of her, and sometimes she merely dangled while we held her weight. We would not give up.

In our book, "Perfect Chaos: A Daughter's Journey To Survive Bipolar, A Mother's Struggle To Save Her," my daughter Linea and I tell a painful story that is only a part of the journey we took, and are still taking. It is all true. When I read Linea's words for the first time, I was filled with agony -- but also with pride. She had written in journals since grade school and continued to write even during her darkest days. She is amazingly honest in her writing and in her life, and she chose to share her deepest thoughts. Hers is a voice of a young person struggling with the painful and difficult life we all share, but one that she has inhabited more deeply, more painfully, perhaps more honestly than most of us. Her words are horrific and sad and even strangely funny at times. Her honesty and willingness to share her writings and her thoughts with me moved us to a place of deeper truth with each other.

It opened the door to a closer relationship that, while often painful, developed into trust and honesty that have moved beyond our family and into the world around us. This honesty changed me. I found strength I didn't know I had. I faced fears that had lurked in the back of my mind for years and, when brought into the light, healed some very old wounds. It was with the guidance of exceptional doctors and nurses, support of family, friends, and occasional angels on earth, and, mostly, the courage of my daughter that we moved from that place of horror to where we are now.

We are privileged in having the resources that allowed Linea to receive the care that she did. In our day-to-day and often minute-by-minute fight for her life, it was very clear to me that we have advantages and therefore a responsibility to add to the understanding about mental illnesses and to advocate for treatment and support for those who aren't nearly as lucky as we are. Ours is a journey through illness, but it is not only that.

It is a journey steeped in love, a love that would not give up on our daughter's life. The energy and time it takes to find good treatment, continued support, and understanding for the person with a mental illness as well as his or her family are often overwhelming, but they are also often the difference between recovery and devastation.

The U.S. Social Security Administration's new Ticket to Work program's stated objectives are "Good Jobs, Good Careers and a Better Self-Supporting Future."

If you are interested in learning more about this program, its various work incentives or how working might affect your Social Security benefits, you should participate in this free webinar, on Wednesday, May 23 from 3:00 - 4:00pm EST. It's entitled, Ticket to Work: Free Support Services for Young Adults in Transition.

Pre-registration is required. Click HERE for more information or to register for the webinar.

The SSA hosts these free webinars on the fourth Wednesday of each month, as part of its WISE (Work Incentives Seminar Events) program. They are well produced in cooperation with Cornell University's Employment and Disability Institute. You can view past topics, view recorded webinars and download PowerPoint slides and transcripts of the presentations, HERE.

The executive functions all serve a "command and control" function; they can be viewed as the "conductor" of all cognitive skills.

Executive functions help you manage life tasks of all types. For example, executive functions let you organize a trip, a research project, or a paper for school.

Often, when we think of problems with executive functioning, we think of disorganization. However, organization is only one of these important skills.

The term "executive functioning" has become a common buzzword in schools and psychology offices. This is more than just a passing fad. In fact, neuropsychologists have been studying these skills for many years.

We believe that the focus on executive functioning represents a significant advancement in our understanding of children (and adults!) and their unique profile of strengths and weaknesses.

"The executive functions are a set of processes that all have to do with managing oneself and one's resources in order to achieve a goal. It is an umbrella term for the neurologically-based skills involving mental control and self-regulation."

What mental control skills are covered under this umbrella? Different researchers and practitioners have their own favorite lists, although the overall concept is basically the same. We use the list proposed by Drs. Gerard A. Gioia, Peter K. Isquith, Steven C. Guy, and Lauren Kenworthy.

Joyce Cooper-Kahn, Ph.D.

These psychologists developed their understanding of executive functions through sound research and created a rating scale that helps parents, teachers, and professionals understand a particular child and think more specifically about how to help.

Before looking at the list of specific characteristics encompassed by the broad category of executive functions, we'd like to provide an example that makes the concepts more concrete.

Understanding Executive Functions by Looking at Life without Them

Thinking about what life is like for someone with weak executive functioning gives us a better understanding of the way these core skills affect our ability to manage life tasks. In the interest of making the concepts immediately relevant and meaningful, our example focuses on an adult, since we assume that most people reading this book are adults, too. Throughout the rest of the book we've included mostly examples of executive functioning in younger people.

The Road Trip without a Map

We'd like to tell you a story about our friend, Robin, who lives life without the benefit of strong executive functioning. Robin is a composite of many individuals we have known, and she struggles with weaknesses in executive skills, despite her well-intentioned efforts to reform herself.

One day in May, Robin gets a phone call from her Aunt Sue in Merryville, Missouri. Aunt Sue is planning a family reunion in July, and she wants to know if Robin and her family can come. All of the extended family will be there. The little town will be overrun with relatives and it is going to be a great corralling of the family from all across the United States. Robin is excited at the prospect and eagerly says, "Of course we'll be there! We wouldn't miss it!"

Aunt Sue gives Robin all the particulars, including the dates of the reunion and places to stay. Robin rummages around in the kitchen junk drawer for a pencil while her aunt talks, but she never does find one with a point on it. She promises to herself to find a pencil and write down all the details just as soon as she gets off the phone. But by the time she hangs up, she can't remember the specifics. She makes a mental note to call back soon to get the dates.

That evening, Robin excitedly tells her husband and two children about the reunion. Her husband asks when it will take place. "Some time in July. I don't remember exactly." He says, "Well, please find out this week because I have to request vacation time at work." Their fifteen-year-old son exclaims, "Hey, I thought July was when I was supposed to go to Band Camp!" "Didn't you remember?" Robin's daughter practically shouts, "I'm going to Ocean City with Julie and her family sometime in July."

Robin blows up at them all, yelling, "Why are you all being so negative? This is supposed to be fun!"

About once a week, Robin's husband reminds her to get the information about the reunion. She promises to do so. (And she really means to get around to it!) Finally, in June, Robin's husband gets very annoyed and says, "Do it now! I'm going to stay right here in the kitchen until you call!" Robin makes the call and gets the dates as well as the other particulars.

Her husband harrumphs around the house the rest of the evening because now he has only three weeks left before the requested time-off. Luck is on their side, though, because he manages to arrange the vacation around work, and the reunion dates do not conflict with the kids' activities.

Over the next three weeks, thoughts about the trip float through Robin's head from time to time. She thinks about how the kids will need to have things to do in the car since it's a long trip. She thinks about taking food and snacks for the ride. She thinks about getting her work at the office cleared up in advance so she can be free of commitments for the vacation. She thinks, "I really should take care of that stuff."

A few days before it is time to leave for the two-day drive to Missouri, she starts piling stuff into the van, including clothes and other supplies. (You can only imagine what the inside of this van looks like!)

Finally, it's time to pile the people into the van, too. On the way out of the house, one of the kids asks, "Who will be taking care of the cats while we're gone?" Robin moans, "Oh no! I forgot about that. We can't just leave them here to die and there's no one to take care of them! Now we can't go. What will we tell Aunt Sue?"

Her husband takes over, calling around the neighborhood until he finds a teenager who can do the pet sitting. The crisis passes. The cats will be fine.

So, they're off. Robin's husband drives the first shift. He pulls out of the neighborhood, gets onto the main highway, and then asks, "So, what's the game plan? What's the route?" Robin answers, "Missouri is west, so I know we have to go west." He looks at Robin incredulously and says, "You don't know any more details than that? Well, get out the map. We can't just head west with no more information that that!" And, of course, Robin says, "What map? I don't have a map." Robin's husband sighs and shakes his head. "Oh no! Another road trip without a map!

Why didn't you tell me you were having trouble getting it all organized? I could have helped." Robin replied, "I didn't have any trouble. Everything is fine. We're in the car, aren't we? We'll get there. What are you so upset about?"

Do you think Robin had made reservations for where to stay along the way? Do you think she had planned out how much cash they would need for the trip or made it to the bank ahead of time?

These and many other details, of course, had escaped planning.

A List of Executive Functions

With this example as a base, let's turn back to the question of what specific abilities are covered under the umbrella term of executive functioning. Below is the list of executive functions from Dr. Gioia and his colleagues. We've included a specific illustration of each executive function from our case study of Robin in parentheses after each definition.

Inhibition - The ability to stop one's own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stop yourself from acting on your impulses, then you are "impulsive." (When Aunt Sue called, it would have made sense to tell her, "Let me check the calendar first. It sounds great, but I just need to look at everybody's schedules before I commit the whole family.")

Shift - The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation. (When the question emerged regarding who would watch the cats, Robin was stymied. Her husband, on the other hand, began generating possible solutions and was able to solve the problem relatively easily.)

Emotional Control - The ability to modulate emotional responses by bringing rational thought to bear on feelings. (The example here is Robin's anger when confronted with her own impulsive behavior in committing the family before checking out the dates: "Why are you all being so negative?")

Initiation - The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies. (Robin thought about calling to check on the date of the reunion, but she just didn't get around to it until her husband initiated the process.)

Working memory - The capacity to hold information in mind for the purpose of completing a task. (Robin could not keep the dates of the reunion in her head long enough to put them on the calendar after her initial phone call from Aunt Sue.)

Planning/Organization - The ability to manage current and future- oriented task demands. (In this case, Robin lacked the ability to systematically think about what the family would need to be ready for the trip and to get to the intended place at the intended time with their needs cared for along the way.)

Organization of Materials - The ability to impose order on work, play, and storage spaces. (It was Robin's job to organize the things needed for the trip. However, she just piled things into the car rather than systematically making checklists and organizing things so important items would be easily accessible, so the space would be used efficiently, and so that people and "stuff" would be orderly and comfortable in the car.)

Self-Monitoring - The ability to monitor one's own performance and to measure it against some standard of what is needed or expected. (Despite the fact that they're off to Missouri without knowing how to get there, with almost no planning for what will happen along the way, and without a map, Robin does not understand why her husband is so upset.)

The executive functions are a diverse, but related and overlapping, set of skills. In order to understand a person, it is important to look at which executive skills are problematic for her and to what degree.

Saturday, May 19, 2012

High School Athletes Also Take Longer Than College Athletes to Recover, Researchers Find

Girls take longer to recover from sports-related concussions than boys do, according to new research.

High school athletes, both boys and girls, also have longer recovery times than do college athletes, says researcher Tracey Covassin, Ph.D., associate professor of kinesiology and a certified athletic trainer at Michigan State University.

"We have known that high school kids will take longer," Covassin tells WebMD. "We are starting to show there are differences between female and male athletes."

Covassin's study evaluated 222 high school and college athletes who had sustained a concussion.

After a concussion, females also did worse than males on visual memory tests. They had more symptoms, Covassin found.

A concussion, a type of traumatic brain injury, results from an impact to the head. Those affected can have headaches, concentration problems, memory and balance problems, blurry vision, and nausea.

A concussion changes the way your brain functions, according to the CDC. It can occur even with a helmet on. Most do not involve loss of consciousness.

The injuries can lead to memory and communication problems, depression and early dementia, the CDC says.

From 2001 through 2005, more than 150,000 sports-related concussions occurred in young people 14 to 19, Covassin says. However, the actual number is probably much higher, she says. The statistics only reflect concussions treated at an emergency department.

Awareness of the problem has grown in the wake of hundreds of lawsuits from former National Football League players. They are suing the NFL for what they claim are concussion-related dementia and other brain problems.

Concussion, Gender, and Age: Study Details

After the concussions, Covassin gave standard tests to measure thinking skills such as verbal and visual memory. She evaluated symptoms. She repeated the tests two, seven and 14 days later.

She also tested the athletes' balance at one, two and three days after the concussion.

High school athletes did worse than college athletes on tests of verbal and visual memory (such as recalling a group of words just read).

Girls and young women did worse than boys and young men on visual memory.

Girls and young women had more symptoms than boys and young men.

"Our high school athletes took longer to recover than college athletes," Covassin says. "The college athletes had recovered by seven days. All [high school and college athletes] went back to normal within 14 days." She cannot pinpoint exactly when the high school athletes recovered.

Exactly why girls have more symptoms is not certain, Covassin says. Some researchers suggest that women's greater rate of blood flow in the brain compared to men's may somehow make the symptoms worse and last longer.

Based on her new findings, teachers and coaches may need to make some accommodations for the athletes whose symptoms are worse and recovery slower, Covassin says.

Some athletes may need to be excused from classes for a few days after concussion, she says.

The new research confirms earlier findings and adds to growing research about gender differences, says Gillian Hotz, Ph.D., director of the concussion program and professor of neurological surgery at the University of Miami Miller School of Medicine.

She reviewed the findings for WebMD.

Educating parents, coaches and youth is key, she says. A crucial message? "If you get a headache [after a hit], pull yourself out," she tells young athletes.

Too often, she says, kids, encouraged by parents and coaches, will play through the pain. "I get parents in my clinic who say, 'They have to play, they have to play,' and they are still recovering from a concussion," Hotz says.

Concussion Education

Parents can be on the lookout for symptoms in their young athletes, Covassin says. Symptoms may come on later, not right after the hit, she says.

As for young athletes, "they need to understand that they need to tell someone [about the hit]." Boys are more likely to play through than are girls, she says.

About 35 states, the District of Columbia and the city of Chicago have passed youth concussion laws, according to a tally by the National Football League, which supports the effort.

The laws require:

Young athletes, parents, and guardians to sign an information form about concussions.

Removal of young athletes from play or practice if a concussion is suspected.

Clearance from a health care professional trained in concussions before an athlete can resume play or practice.

Previous research tells us that students who see intelligence and ability as fixed will tend to give up when confronted by a difficult problem, whereas those who see intelligence as growable will persevere. But how do teachers' beliefs about ability affect the way they perceive and respond to their students' performance?

A new investigation led by Aneeta Rattan, together with Carol Dweck, the doyenne of this area, and Catherine Good, began by asking 41 undergrads about their beliefs regarding maths ability (e.g. did they agree that "You have a certain amount of math intelligence and you can't really do much to change it"?). Asked to imagine they were a maths teacher responding to a student's initial poor maths exam result, those undergrads who endorsed this fixed "entity" theory of maths ability tended to jump to conclusions - assuming that their student had struggled because he or she lacked maths ability.

A second study was similar but went further and showed that undergrad participants who believed ability is fixed were more likely to say that they'd comfort their student for his or her poor maths ability (e.g. they said they'd "explain that not everyone has maths talent"), and that they'd pursue strategies such as setting the student less maths homework.

A third study elevated the realism levels a little by recruiting postgrads who worked as teachers or research demonstrators in their university departments. The same findings emerged - participants who saw maths ability as fixed were more likely (than those who saw ability as malleable) to make premature, ability-based assumptions about the reasons why a student was struggling, and they were more likely to respond by comforting the student for their poor ability and by pursuing counter-productive teaching strategies, such as encouraging the student's withdrawal from the subject.

So, what's it like for a struggling student to receive this kind of treatment from their teacher? A final study with 54 students asked them to imagine they'd struggled at an initial maths test. Some of them then received comforting feedback ("I want to assure you that I know you're a talented student in general, it's just the case that not everyone is a maths person. I'm going to give you some easier tasks ... etc"); others received constructive strategy tips (e.g "I'm going to call on you more in class and I want you to work with a maths tutor"); and others received neutral, control feedback. The key finding here was that the students who received the comforting feedback felt their teacher had low expectations for them and felt less encouraged and optimistic about their future prospects in the subject.

Rattan and her colleagues said their findings pointed to some important real-world implications. University teachers who form fixed-ability judgements about their students and who provide comfort may be well-intentioned, but they risk derailing their students' chances before they've even had the opportunity to get going. "As upsetting as poor performance may be to a student," the researchers concluded, "receiving comfort that is oriented toward helping them to accept their presumed lack of ability (rather than comfort that is oriented toward helping them to improve) may be even more disturbing."

Friday, May 18, 2012

Times are tough for young people. Unemployment is high, and college costs are soaring.

For those who've been diagnosed with autism, the challenges of life after high school are even steeper, according to a study just published in the journal Pediatrics.

Within the first six years of getting out of high school, only a little more than one-third of young people previously diagnosed with an autism spectrum disorder, or ASD, had gone to college, and only a slim majority — 55 percent — had held paying jobs.

The first two years after high school are particularly hard, the researchers found, with less than half of the young people with an ASD having had any work.

The researchers compared the experience of the young people with autism to those with mental retardation, learning disabilities and impaired language or speech. Those with autism fared worse than the others when it came to jobs, the researchers found.

On the college front, those with autism were more likely than those with mental retardation to have attended some college but less like to have done so than those in the other two comparison groups.

"It appears that youth with an ASD are uniquely at high risk for a period of struggling to find ways to participate in work and school after leaving high school," the researchers wrote. The findings, they said, point to a need for support during the transition from high school to life afterward.

The data for the analysis came from a long-running study of young people and concentrated on those receiving special education services. The researchers looked at the experience of more than 600 people in the autism category, and more than 400 each in the comparison categories.

The ranks of candidates for such intervention are growing. According to the latest federal estimates for autism, released in March, the number of children diagnosed with autism jumped 23 percent between 2006 and 2008. About 1 in 88 kids has been diagnosed with autism, the figures from the Centers for Disease Control and Prevention showed.

NOTE: You can also read an article specifically concerning OCD in childrenHERE.

April, 2012

Obsessions are intrusive, irrational thoughts—unwanted ideas or impulses that repeatedly appear in a person's mind. Again and again, the person experiences disturbing thoughts, such as "My hands must be contaminated; I need to wash them"; "I may have left the gas stove on; I need to go check it fast"; "I am going to injure my child by accident; I need to be very careful or else something bad will happen."

On one level, the person experiencing these thoughts knows their obsessions are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety, distress and dysfunction.

"Individuals living with OCD experience "pathological doubt" because they are unable to distinguish between what is possible, what is probable and what is unlikely to happen."

Compulsions are repetitive rituals such as hand washing, counting, checking, hoarding or arranging. An individual repeats these actions many times throughout the day and performing these actions releases anxiety, but only momentarily. People with OCD feel they must perform these compulsive rituals or something bad will happen to them or their loved ones.

Most people at one time or another experience obsessive thoughts or compulsive behaviors. Obsessive-compulsive disorder occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life. The National Institute of Mental Health estimates that more than 2 percent of the U.S. population, or nearly one out of every 40 people, will be diagnosed with OCD at some point in their lives. The disorder is two to three times more common than schizophrenia and bipolar disorder.

OCD is often described as "a disease of doubt." Individuals living with OCD experience "pathological doubt" because they are unable to distinguish between what is possible, what is probable and what is unlikely to happen.

People from all walks of life can get OCD. It strikes people of all social and ethnic groups and both males and females. Symptoms typically begin during childhood, the teenage years or young adulthood. The sudden appearance of OCD symptoms later in life merits a thorough medical evaluation to ensure that another illness is not the cause of these symptoms.

What causes OCD?

People with OCD can often say "why" they have obsessive thoughts or “why” they behave compulsively, but the thoughts and the behavior continue. A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. For years, mental health professionals incorrectly assumed OCD resulted from bad parenting or personality defects. This theory has been disproven over the last few decades.

People whose brains are injured sometimes develop OCD, which suggests it is a medical condition. If a placebo pill is given to people who are depressed or who experience panic attacks, nearly 40 percent will say they feel better. If a placebo is given to people who experience obsessive-compulsive disorder, only about two percent say they feel better. This also suggests that OCD is a biological condition as opposed to a “personality problem.”

Genetics are thought to be very important in OCD. If you, or your parent or sibling, have OCD, there's close to a 25 percent chance that another of your immediate family members will have it.

OCD has been found to be connected with dysfunction in certain parts of the brain, specifically the basal ganglia and the frontal lobes. Inappropriate functioning of these regions in the brain can cause the repetitive movements and rigid thinking that effects people with OCD. Successful treatment with medication or behavior therapy changes the activity in these brain regions, which decreases the symptoms of OCD.

Two specific chemicals in the brain—a neurotransmitter called serotonin and a hormone called vasopressin—have also be studied by scientists who have found a link between these chemicals and OCD. Researchers believe OCD, anxiety disorders, Tourette's and eating disorders, such as anorexia and bulimia, can be triggered by some of the same chemical changes in the brain.

A world-renowned expert, Judith Rapoport M.D., describes OCD by writing, “something in the brain is stuck, like a broken record.”

How do people with OCD typically react to their disorder?

People with OCD generally attempt to hide their problem rather than seek help. Often they are remarkably successful in concealing their obsessive-compulsive symptoms from friends and co-workers. An unfortunate consequence of this secrecy is that people with OCD generally do not receive professional help until years after the onset of their disease when symptoms have become too severe to control. By that time, the obsessive-compulsive rituals may be deeply ingrained and very difficult to change.

OCD usually starts at an early age, often before adolescence. It may be mistaken at first for autism, pervasive developmental disorder or Tourette's syndrome: a disorder that may include obsessive doubting and compulsive touching as symptoms.

Like depression, OCD tends to worsen as the person grows older, if left untreated. Scientists hope, however, that when the OCD is treated while the person is still young, the symptoms will not get worse with time.

What are other examples of behaviors typical of people who live with OCD?

People who do the following may have OCD:

Repeatedly check things, perhaps dozens of times, before feeling secure enough to leave the house. Is the stove off? Is the door locked?

Fear they will harm others. Example: A man's car hits a pothole on a city street and he fears it was actually a pedestrian and drives back to check for injured persons.

Feel dirty and contaminated. Example: A woman is fearful of touching her baby because she might contaminate the child and cause a serious infection.

Constantly arrange and order things. Example: A child can't go to sleep unless he lines up all his shoes correctly.

Are ruled by numbers, believing that certain numbers represent good and others represent evil. Example: a college student is unable to send an email unless the “correct sequence of numbers” is recalled prior to using his computer.

Are excessively concerned with sin or blasphemy in a way that is not the cultural or religious norm for other members of their community. Example: a woman must recite “Hail Mary” thirty-three times every morning before getting out of bed and is frequently late for work because of this.

Is OCD commonly recognized by professionals?

Not nearly commonly enough. OCD is often misdiagnosed, and it is often underdiagnosed. Many people have dual disorders of OCD and schizophrenia, or OCD and bipolar disorder, but the OCD part of their illness is not diagnosed or treated. In children, parents (and teachers and doctors) often are aware of some anxiety or depression but not of the underlying OCD.
Can OCD be effectively treated?

OCD will not go away by itself, so it is important to seek treatment. Although symptoms may become less severe from time to time, OCD is a chronic disease. Fortunately, effective treatments are available that make life with OCD much easier to manage. OCD symptoms are not cured by talking about them and “trying to make it go away.” With medication and behavior therapy, OCD can be treated effectively. Both medications and behavioral therapy affect brain chemistry, which in turn affects behavior.

Doctors are also increasingly aware of the role that regular exercise, getting enough sleep, and a healthy diet have in the treatment of OCD. If a person with OCD can live a healthy lifestyle and receive effective treatment of any other medical conditions they might have, it is likely that their OCD symptoms will improve.

The most common side effects associated with these medications are upset stomach (including nausea, constipation, diarrhea and vomiting), problems sleeping (both insomnia and excessive sleepiness), dizziness and headache. Some people experience sexual side-effects including problems with maintaining an erection or difficulty having an orgasm. It should also be noted that the FDA (The United States Food and Drug Administration) has placed a “Black Box Warning” on all of these medications suggesting that there may be an increased risk of suicidal thoughts and behaviors in people taking these medications.

That is why all people who are thinking of taking medications should have a thorough discussion with their doctors prior to starting any medication in order to fully understand the benefits and risks of beginning a new treatment.

Some physicians make the mistake of prescribing an antidepressant medication for only three or four weeks before judging that it’s working or not. That simply isn't long enough. Medication should be tried consistently for 10 to 12 weeks before its effectiveness can be judged.

Other medications are often prescribed to help treat severe symptoms of OCD. Of these additional medications, some of the most frequently prescribed include antipsychotic medications such as risperidone (Risperdal) and haloperidol (Haldol). Other medications have also been tried in people with OCD but their effectiveness and safety have not been studied as thoroughly as some of the medications mentioned in this article.

About one-half of people who are treated with medications will have a positive response to treatment. It is often recommended that people who experience a positive response to treatment with medications will continue this treatment for up to 1-2 years even after their symptoms improve. This is something that should be discussed with each individual’s physician.

What is behavior therapy, and can it effectively relieve symptoms of OCD?

Behavior therapy is not traditional psychotherapy. It is often called Cognitive-Behavior Therapy or "Exposure and Response Prevention," and it is highly effective for many people with OCD. People with OCD are deliberately exposed to a feared object or thought, either directly or by imagination, and are then discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand-washer may be urged to touch an object he or she believes is contaminated and denied the opportunity to wash for several hours.

This helps people to become accustomed to dealing with an uncomfortable situation and to learn how to decrease the associated anxiety. When the treatment works well, the person gradually experiences less anxiety from the obsessive thoughts and becomes able to refrain from the compulsive actions for extended periods of time.

About one-half of the people with this disorder who receive behavioral therapy improve substantially; the rest improve moderately.

Response to treatment varies from person to person. Several studies suggest that medication and behavior therapy are equally effective in alleviating symptoms of OCD. Furthermore, the combination of medications and therapy has been found in many cases to be superior to either treatment on its own.

A small percentage of people with OCD find that neither medication nor behavioral treatment produces any significant change. Most people who receive effective treatments find their symptoms reduced by about 40 percent to 50 percent. That can often be enough to change their lives, to transform them into individuals who can go back to school, work and their families. Another percentage of people are fortunate to have a complete remission of their symptoms when treated with effective medication and/or behavior therapy.

NESCA Transition Specialist Sandra Storer, LICSW will be speaking from 7:00 - 9:00 pm on Thursday, June 14th at Groton-Dunstable Regional High School. Her presentation will stress the need for families of children with significant special needs to initiate the transition planning process early, even prior to age 14 if possible, to assure that appropriate supports and programming are in place for as long as they need to be.

Storer will also discuss the Transition Planning Form (TPF), and how to use it to your child's best advantage. The TPF is the official document, updated annually, that asks children and their families the essential questions, "Where do you hope to go in life," and "What must we do to help you get there?"

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Welcome to NESCA!

This is NESCA's newspaper, and you can easily have it delivered daily to your inbox. In it, you'll find updates about our pediatric neuropsychology practice in Newton, MA and discussions on other topics of interest, as well as announcements of upcoming special events.

We will also provide timely reports on significant developments in science, education and the law as they relate to children with neurologically-based special needs, including learning disabilities, emotional or attentional problems, executive functioning deficits and autism spectrum disorders, along with links to carefully-screened and reliable sources of additional information on these subjects.

Our goal is that this become an important resource supporting our clients and their families.